A step change is needed so that anyone at risk of a heart attack or stroke has equal access to NICE- approved care – ending the variation across the country.

 

For several years our founders have been working to address head-on the wicked problem of how to prevent the thousands of avoidable heart attacks and strokes every year.

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CVD is a leading cause of premature death, health inequalities, economic inactivity and high cost to health and social care. It is also highly preventable:

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• firstly through support for lifestyle change (eg obesity, physical inactivity and smoking);

• secondly through use of high impact treatments in high-risk conditions such as blood pressure, high cholesterol, diabetes and chronic kidney disease.

 

Despite robust evidence that these treatments are highly effective at preventing CVD, there is longstanding underuse and wide variation. And in England, despite major drivers of clinical improvement such as NICE guidance, Care Quality Commission inspections and Quality & Outcomes Framework incentives, optimal treatment levels in primary have changed little in many years, with improvements being marginal at best.

 

Size of the Prize shows the scale of the challenge and the scale of the opportunity. For example in England a third of people with diagnosed hypertension are not treated to target. Improving care so that 4 in 5 people were treated to target would prevent around 6,000 heart attacks and strokes every year, with major savings for the economy.

 

It is time to challenge our tolerance of this wicked problem that sees thousands of avoidable, life changing heart attacks and strokes every year.

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Indeed the national Mission to reduce deaths from CVD by a quarter in ten years will not be delivered without a step change in the treatment of the high risk conditions.

 

Our starting point, is to acknowledge that optimal care is hard to deliver in real world primary care:

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• complexity, multimorbidity and time pressure is the norm,

• clinical culture is driven by incentives that reward limited achievement on one day in the year,

• patients find access difficult,

• staff have no head space to even consider reform

 

To deliver a step change in care and outcomes, real world solutions need to address these real world challenges.